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General NPI Number Information
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NPI Number | 1235448291
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Entity Type | Organization
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Legal Business Name | SDT VISIONTHEHOPE
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 1302 HENDRICK
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City | DALLAS
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State | TX
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Zip | 75216
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Country | US
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Telephone | 214-728-9902
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Fax |
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Provider Business Mailing Address
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Address Line | 6505 ATHA DR
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City | DALLAS
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State | TX
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Zip | 75217-5612
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Country | US
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Telephone | 214-728-9902
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DIANNE TATUM
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Credential |
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Telephone | 214-728-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 103717
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 103717
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 103717
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 103717
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 103717
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License Number State | TX
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